Hematological Manifestation in Haart Naive HIV-1 Infected Children in India in a Resource Limited setting
Ira Shah, Bhushan Katira
Pediatric HIV Clinic, B. J. Wadia Hospital for Children, Parel, Mumbai, India
Abstract

Aim:
Hematological problems in HIV infected children have never been studied in India. This study was thus undertaken to assess the hematological manifestations in HAART naive HIV-1 infected children.

Setting:
Pediatric HIV Clinic at B.J.Wadia Hospital for Children, Mumbai

Study Design:
Prospective cross-sectional study.

Methods & Materials:
50 HIV infected children referred to our HIV Clinic over a period of 6 months in 2005 underwent a baseline hematological analysis. All patients underwent a through clinical examination and factors such as age, sex, growth, CD4 count, opportunistic infections and their association with various hematological manifestations were studied.

Results:
45 patients (90%) had elevated ESR, 35 patients (70%) had anemia, 14 patients (28%) had leucocytosis, 12 patients (24%) had lymphopenia, 5 patients (10%) had thrombocytopenia and 1 patient (2%) had leukopenia with neutropenia. Patients with lymphopenia had a mean age of 6.8+3.5 years Vs 4.7 + 2.1 years which was statistically significant (p = 0.01) whereas patients with thrombocytopenia had a mean age of 7.5 + 4.1 years Vs 5.0 + 2.3 years (p = 0.03) and patients with elevated ESR had a mean age of 4.9+ 2.3 years Vs 7.6 + 4.0 years (p = 0.03). All patients with anemia had microcytic hypochromic anemia. Thrombocytopenia was more common in patients with Tuberculosis in the past (p = 0.049). There was no correlation with lymphopenia and decrease in CD4 count (p=0.81) or CD4 percent (p=0.34). Growth parameters, sex, mode of transmission, immunological profile and opportunistic infections had no statistical association with hematological manifestations.

Conclusion:
Hematological problems in HIV infected children in India are common. Elevated ESR and anemia are the commonest features. Elevated ESR may be used as a marker to screen a child for HIV infection. Microcytic hypochromic anemia is the commonest type of anemia seen.
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